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Tytuł pozycji:

Supervision and Care Quality as Perceived by Redeployed Attendings, Fellows, and Residents During a COVID-19 Surge: Lessons for the Future.

Tytuł:
Supervision and Care Quality as Perceived by Redeployed Attendings, Fellows, and Residents During a COVID-19 Surge: Lessons for the Future.
Autorzy:
Young JQ; J.Q. Young is professor, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0003-2219-5657 .
Friedman KA; K.A. Friedman is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; ORCID: https://orcid.org/0000-0003-1980-1839 .
Thakker K; K. Thakker is research associate, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York.
Hennus MP; M.P. Hennus is professor, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID: https://orcid.org/0000-0003-1508-0456 .
Hennessy M; M. Hennessy is associate professor, Trinity College Dublin School of Medicine, Dublin, Ireland; ORCID: https://orcid.org/0000-0002-2153-5288 .
Patterson A; A. Patterson is assistant professor, Trinity College Dublin School of Medicine, Dublin, Ireland; ORCID: https://orcid.org/0000-0003-4315-0917 .
Yacht A; A. Yacht is professor, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Ten Cate O; O. ten Cate is a professor, University Medical Center Utrecht, Utrecht, The Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780 .
Źródło:
Academic medicine : journal of the Association of American Medical Colleges [Acad Med] 2022 Mar 01; Vol. 97 (3S), pp. S28-S34.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: Philadelphia, PA : Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins
Original Publication: [Philadelphia, Pa. : Hanley & Belfus, c1989-
MeSH Terms:
Attitude of Health Personnel*
COVID-19*
Internship and Residency*
Medical Staff, Hospital*
Quality of Health Care*
SARS-CoV-2*
Cross-Sectional Studies ; Hospitals, Teaching ; Humans ; New York ; Surveys and Questionnaires
References:
Dennis B, Highet A, Kendrick D, et al. Knowing your team: Rapid assessment of residents and fellows for effective horizontal care delivery in emergency events. J Grad Med Educ. 2020;12:272–279.
Flotte TR, Larkin AC, Fischer MA, et al. Accelerated graduation and the deployment of new physicians during the COVID-19 pandemic. Acad Med. 2020;95:1492–1494.
World Health Organization. Coronavirus disease (COVID-19): Situation report–111. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200510covid-19-sitrep-111.pdf?sfvrsn=1896976f_6 . Published May 10, 2020. Accessed August 26, 2020.
Fraher EP, Pittman P, Frogner BK, et al. Ensuring and sustaining a pandemic workforce. N Engl J Med. 2020;382:2181–2183.
Hall AK, Nousiainen MT, Campisi P, et al. Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic. Med Teach. 2020;42:756–761.
Ross SW, Lauer CW, Miles WS, et al. Maximizing the calm before the storm: Tiered surgical response plan for novel coronavirus (COVID-19). J Am Coll Surg. 2020;230:1080–1091.e3.
Eva KW, Regehr G. Self-assessment in the health professions: A reformulation and research agenda. Acad Med. 2005;80(suppl 10):S46–S54.
Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77:1121–1134.
Finn KM, Metlay JP, Chang Y, et al. Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: A randomized clinical trial. JAMA Intern Med. 2018;178:952–959.
Miller MK, Clark JD, Jehle A. Cognitive dissonance theory (Festinger). Wiley Online Library. Published October 26, 2015. doi: 10.1002/9781405165518.wbeosc058.pub2.
Klein J, McColl G. Cognitive dissonance: How self-protective distortions can undermine clinical judgement. Med Educ. 2019;53:1178–1186.
Kopacz MS, Ames D, Koenig HG. It’s time to talk about physician burnout and moral injury. Lancet Psychiatry. 2019;6:e28.
Dean W, Talbot S, Dean A. Reframing clinician distress: Moral injury not burnout. Fed Pract. 2019;36:400–402.
Ford EW. Stress, burnout, and moral injury: The state of the healthcare workforce. J Healthc Manag. 2019;64:125–127.
Groot F, Jonker G, Rinia M, Ten Cate O, Hoff RG. Simulation at the frontier of the zone of proximal development: A test in acute care for inexperienced learners. Acad Med. 2020;95:1098–1105.
Vygotsky LS. Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press; 1978.
Entry Date(s):
Date Created: 20211118 Date Completed: 20220308 Latest Revision: 20230717
Update Code:
20240105
PubMed Central ID:
PMC8855770
DOI:
10.1097/ACM.0000000000004529
PMID:
34789660
Czasopismo naukowe
Purpose: To better prepare for potential future large-scale redeployments, this study examines quality of supervision and care as perceived by redeployed residents, fellows, and attendings during a COVID-19 surge.
Method: During April and May 2020, attendings, fellows, and residents redeployed at 2 teaching hospitals were invited to participate in a survey, which included questions on respondents' prior experience; redeployed role; amount of supervision needed and received; and perceptions of quality of supervision, patient care, and interprofessional collaboration. Frequencies, means, and P values were calculated to compare perceptions by experience and trainee status. Narrative responses to 2 open-ended questions were independently coded; themes were constructed.
Results: Overall, 152 of 297 (51.2%) individuals responded, including 64 of 142 attendings (45.1%), 40 of 79 fellows (50.6%), and 48 of 76 residents (63.2%). Fellows and attendings, regardless of prior experience, perceived supervision as adequate. In contrast, experienced residents reported receiving more supervision than needed, while inexperienced residents reported receiving less supervision than needed and rated overall supervision as poor. Attendings, fellows, and experienced residents rated the overall quality of care as acceptable to good, whereas inexperienced residents perceived overall quality of care as worse to much worse, particularly when compared with baseline.
Conclusions: Narrative themes indicated that the quality of supervision and care was buffered by strong camaraderie, a culture of informal consultation, team composition (mixing experienced with inexperienced), and clinical decision aids. The markedly negative view of inexperienced residents suggests a higher risk for disillusionment, perhaps even moral injury, during future redeployments. Implications for planning are explored.
(Copyright © 2021 by the Association of American Medical Colleges.)

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